Laryngeal Photos: Inflammation

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Leukoplakia

Leukoplakia is a white patch on the vocal fold. It may be from any irritation such as reflux or smoking.

Leukoplakia covers not only the vocal cords, but also the interarytenoid area as well.

Granuloma

Granulomas are typically located over the vocal process of the arytenoid cartilage. They may be caused from intubations during anesthesia or from vocal trauma (typically speaking at too low a pitch). Click on the photo to see a range of types of granulomas.

Granulomas may form with a chronic cough. At left is the view with breathing. At right is the view during phonation.

Granulomas most commonly seem to form with vocal strain or overuse. I see them in patients with vocal cord bowing as they close the vocal process cartilages firmly against each other. This man had his granuloma recur after each removal, which suggests that unless you correct the vocal overclosure, the granulomas will return because of the ongoing trauma. This granuloma is very mature (very white) and will likely fall off soon. You can see the groove in the granuoma formed where it strikes the opposite vocal process.

Fungal

This is the most typical view of fungal laryngitis. It is not as striking as the photos below. There is a central white coating that can be quite thin with a surrounding erythema. It seems to be most frequently associated with ADVAIR HFA Inhalers (fluticasone propionate and salmeterol)

Left: This is how subtle fungal laryngitis can be. If someone is on an inhaler for asthma, particularly ADVAIR HFA Inhalers (fluticasone propionate and salmeterol) and they are hoarse, a very detailed examination is required. If you click on the left photo, you can see that the dilated blood vessels fade in the middle of the vocal cord. They are under a faint opaque layer of fungus.

Right: After treatment, the blood vessels are smaller, and there is no longer a light opaque covering on the vocal cords. His stroboscopy showed a much more supple mucosal wave. His stroboscopy exam is featured in the video on Reflux.

Left: Patient with hoarseness (treated extensively with anti-reflux medication) who was using an Advair inhaler. The left cord is swollen with a white patch on it.

Right: After 30 days treatment with fluconazole and stopping the steroid inhaler the voice and vocal cords have returned to normal.

Fungal infection from steroid inhaler. This is most common in asthmatic patients dependant on steroid inhalers.

A more extensive fungal infection from a steroid inhaler. Candida is the most common organism.

When one's immune system is suppressed by something like chemotherapy, a fungal infection may be quite extensive.

A fungal infection called coccidomycosis that is from California's Central valley.

Bacterial infection

Left: A bacterial infection of the larynx is very serious as the swelling can nearly close off the airway in an adult and easily closes off the airway in a child. It is typically called epiglottitis or supraglottitis. The danger lies in the softness of the tissue which can easily expand, particularly the loose tissue of the arytenoids can be drawn in during inspiration. Here the arytenoids are very swollen and limiting the opening of the vocal cords.

Right: After two days of antibiotics and some steroids, the swelling (and pain) has greatly improved.

Viral infection

Left: This is the common winter cold. The vocal cords are pink and swollen, the voice deep, the secretions thick.

Right: The vocal cords have returned to normal

Laryngitis sicca

Laryngitis sicca, or laryngeal dryness is a condition for which I have not found a cause nor have I found a solution. Some people have speculated that it is an autoimmune phenomenon, but I have not been able to confirm that.